I was diagnosed with diabetes 7+ years ago, found out about 5 years ago it was LADA. Started on insulin about 3 years ago, and as the diabetes has progressed, I have gradually increased from just basal insulin to basal (Levemir) morning and evening and Humalog with every meal. I have been thinking that it might be time to look into a pump. Based on the research I have done, I am convinced that for me only the Omnipod would be preferable to MDI. So the pros and cons I have read about are summarized below.
HbA1c: I eat low carb (30 to 50 carbs per day) and keep my HbA1c between 5.3 to 5.7. I see that the lowest setting for target glucose on the Omnipod is 110. I am worried that a hybrid closed loop would not be able to give that good results, particularly because the algorithms are based on eating a higher carb diet. However, I could keep it in manual and perhaps get even better control with adjustable basal rates.
Infusion site problems. This seems to be what causes many people to go back to MDI.
I am fond of my Libre3 CGMs. No need to calibrate and only need to change every 14 days. The Dexcom 6 needs calibration, doesn’t it? And only lasts 10 days.
If I had my druthers, I would go manual with an Omnipod Dash with Libre3, but it looks like my insurance would force me to get the Onmipod5/Dexcom6 combo.
I’m thinking about how nice it would be to not have to go to the restroom to inject insulin at restaurants, just initiate bolus by phone.
We’re planning some trips to Europe and Asia and dealing with the time changes for basal injections would seem to be much easier with a pump.
We live on a lake and do a lot of swimming in the summer, which is one of the main reasons I don’t like the idea of a tubed pump.
So since you all are a team of experienced experts, should I go for it? Do any of you eat a low carb diet and use an Omnipod? Or any other type of pump? I understand that there is no long term commitment with the Omnipod, so I could at least give it a try and switch back to MDI if I don’t like it. I have an endo appointment coming up in about a month, so that would be the time to make the change. I am interested in what you all think.
Couple of things to consider 1. Hybrid Closed Loop pumps suspend on low and can increase delivery on high. Maintaining your target numbers and time in range is still up to you. Which means the pump targets are not a deciding factor. 3. Rumor is Abbott is going to release a Libre 3 plus later this year and that is what the pumps are going to support. Here’s where I heard the rumor and is also a great summary of the current pumps. Taking Control Of Your Diabetes® - The Podcast! | Evaluating Diabetes Technology: The Pros & Cons of Different Devices, with David Ahn, MD Dexcom G6 and newer don’t require calibration. 4. If you are considering going manual just go manual with the Omnipod5. Libre compatibility should be out in the second half of this year along with G7 support. 8. Levemir is being discontinued in the US this year so you should talk to your endo about a replacement in addition to a pump You always need something on hand in case the pump goes down or you can’t get new ones.
With Loop, you can set whatever BG target you want. And you use your actual phone, not the extra PDM phone that comes with the Omnipod 5 or the PDM that you are “supposed” to use with Omnipod Dash.
While I’m not personally a fan of Omnipod because it doesn’t work for me, the great thing about them is that there’s no strings attached. There’s no big commitment to them, like with my preferred brand of pump. If you have private insurance, you can even sign up for a10-day free trial on their website.
There’s literally no reason to agonize over the decision. Try it, and see if you like it. If you don’t, don’t order more. If you do like it, continue on.
Even though I didn’t have success with them, I still quite like having some pods on the shelf. It’s good to have choices and backups.
I was recently talking to a pod user in my endo’s waiting room. She used one pod a week, just for the three days she worked in a courthouse, because she found it easier than dealing with injections in that environment. On the other days of the week, when she was in her home office or over the weekend, she switched to MDI. She loved the balance. It got me thinking…
I don’t know about trial offers by Medtronic, though I think there are a few weeks to return it if there’s a problem. I don’t know the details. I had a rocky adjustment period for a few weeks with my Medtronic 780, but now I love it! Omg….it’s a huge help to me with management. At this point, I’m completely satisfied. If I could get A1c in 5-6 range with MDI, I’d go MDI, but I can’t, so this is the best option for me right now.
Imo, a pump with integrated CGM requires a lot of work. But, the benefits are priceless. For someone who’s in water a lot……I’d give it a lot of thought. I use extra adhesive and don’t spend much time in tne pool. I want to swim laps at the gym, but to me it’s not feasible.
I would not initiate any major changes to your treatment regime during foreign travel.
I think that this is how you figure out if its a good fit.
I think that you should start out with the hardware and figure out good basal and bolus rates (these doses change for some people when they start using the pump). Run it manual for 6 months and get to know the hardware. After 6 months you will be able to identify if the pump works for your body, what its little quirks are, and what hardware failure looks like and how quickly you need to respond to it. By then, you will have a procedure for responding to hardware failure and you will know what benefits you can derive from being on a pump VS manual injection.
After that, if you want to add a complex software system on top of it, I think you should go for it.
I still run a manual omnipod. I have run on automated systems, but this is the best fit for me. I don’t think it hurts for you to become acquainted with all the tools you have at your disposal. One solution might be a better fit for you during certain periods of your life and a different solution might be better under different circumstances.
You will need to respond very quickly to failures in the system and to do that you will need to have some experience troubleshooting hardware failures vs problems in your software settings. That’s hard.
I never go to a rest room to inject. Not clean. I just inject at my seat. This is a normal part of my life, and I don’t care if anyone stares, although I do this pretty circumspectly. Much better with pants or a skirt than a dress (in which case I might look for a private spot but not in a restroom). In ten years, no one has stared or said anything to me. All my family and friends see me inject all the time, I am very matter of fact about it and it takes less than a minute.
Do a lot of traveling and injecting has never been a concern past our travel and arrival date, when I do need to account for time changes.
Good luck and let us know how it works out for you.
I wholeheartedly agree with @Susan4. I avoid public restrooms like the plague. When doing MDI, I always dosed through my clothes right at the table. Midriff was my choice of body location. It is below the level of the table and took me no more than 30 seconds to accomplish.
Just a caveat that these 1 month trial periods can be more notional than real. Particularly if you’re new to pumping, that period can end up being a lot shorter than it looks. There’s a lot of new info to absorb, practicalities about infusion set changes and the like, testing and getting your settings dialed in (pro tip: they are NOT going to translate 1:1 from the parameters you’re using for MDI), not to mention getting your calendar to match up with the trainer’s availability. Not to mention any glitches in getting all the supplies assembled, which may or may not count against your time. Over some 15-odd years I’ve transitioned from MDI to a (pre-AID) pump, from that pump to an AID pump, and from one AID system (Medtronic) to another (Tandem). In NONE of those cases has 4 weeks been sufficient to get 100% familiar with the new system and feel like it was fully dialed in. Anecdotal reports of people discovering their trial period has lapsed by the time they determined they were unhappy with whatever system they’d picked are easy to find.
This is NOT meant to be discouraging—I could go on at length about why I personally consider pumping superior to MDI. It’s just that in my experience these systems are subject to a lot of happy-talk from the manufacturers in ways that are not necessarily helpful to your expectations management. So if it’s important to your decision I’d lean on the pump maker to be as specific as possible on when they consider the clock to start ticking. They may start the countdown from the date of shipment, yet you can’t schedule trainer meetings until you have all the parts in hand, and your first session can be a week or two out from there.
I was never embarrassed to take finger sticks (before I had CGM) or inject insulin in public either. What I always found incredible is that I never saw anyone else ever do it! In over 20 years! And, I went out a lot! Even at TCOYD conferences! I used to wonder what other T1s did. I was so handy with it that I could test by finger stick while standing in line at the bank. Lol.
Regardless of how you get acclimated to an integrated pump, I suspect you’d love it.
Did you decide to try an Omnipod or stick with MDI? I’ve also got a trip planned to a far off land and just realized I’ll have to pay attention to my Lantus timing.
Here’s an update to my plans: I met with my endo and decided to try the Omnipod Dash. I found out Medicare will cover the cost. I decided to keep using the Freestyle Libre 3 and do manual control of my glucose, so it will be not too different from MDI since I will not be handing over my glucose control to an algorithm. Still have to schedule my training and get started. I am still keeping the idea of DIY looping in the back of my mind for the future and will be following Tidepool Loop which is trying to get FDA approval of looping. (Anybody know much about this?)
Interesting to hear how many of you inject insulin at the table when dining out - gives me confidence to do that.
I’m not doing international travel until October, so should be pretty settled with Omnipod (assuming it works for me) before traveling. Thanks to all who have replied!
I hope that you love your new pump. I have always used MDI and I just thought that I would share that I use insulin pens and I inject in restaurants at the table through my clothes. It takes me about 10 seconds. Actually i inject whenever i need to no matter where I am. I have never been questioned about it. Most people don’t notice.
One Omnipod thing to practice or experiment with in prep for your travel is how to best do a large bolus and extended bolus. The carb content and glycemic speed we end up eating while traveling is usually hard to figure out as is portion control at restaurants. These challenges can create the need for some heroic sized bolusses. Another thing that can change with travel is your basal: different amounts of walking all day, different total daily carbs, sleep differences, etc.
The Omnipod has trouble with large bolusses not absorbing properly….many users will limit Omnipod bolus to about 5 units and either use extended bolus or shots for the remainder. There also are pod locations that will absorb better/quicker than others. The more experimenting with bolus absorption the better, it will help you make adjustments while travelling.
